Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry. (18th February 2019)

• Record Type: Journal Article
• Authors: Jansen, Ivo GH; Mulder, Maxim JHL; Goldhoorn, Robert-Jan B; Boers, Anna MM; van Es, Adriaan CGM; Yo, Lonneke SF; Hofmeijer, Jeannette; Martens, Jasper M; van Walderveen, Marianne AA; van der Kallen, Bas FW; Jenniskens, Sjoerd FM; Treurniet, Kilian M; Marquering, Henk A; Sprengers, Marieke ES; Schonewille, Wouter J; Bot, Joost CJ; Lycklama a Nijeholt, Geert J; Lingsma, Hester F; Liebeskind, David S; Boiten, Jelis; Vos, Jan Albert; Roos, Yvo BWEM; van Oostenbrugge, Robert J; van der Lugt, Aad; van Zwam, Wim H; Dippel, Diederik WJ; van den Wijngaard, Ido R; Majoie, Charles BLM
• Other Names: author non-byline.; J Dippel Diederik W author non-byline.; Der Lugt Aad Van author non-byline.; L M Majoie Charles B author non-byline.; W E M Roos Yvo B author non-byline.; Van Oostenbrugge Robert J author non-byline.; Van Zwam Wim H author non-byline.; Boiten Jelis author non-byline.; Vos Jan Albert author non-byline.; H Jansen Ivo G author non-byline.; H L Mulder Maxim J author non-byline.; Goldhoorn Robert-Jan B author non-byline.; Schonewille Wouter J author non-byline.; Coutinho Jonathan M author non-byline.; H Wermer Marieke J author non-byline.; A van Walderveen Marianne A author non-byline.; Staals Julie author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M author non-byline.; Lycklama à nijeholt Geert J author non-byline.; Roozenbeek Bob author non-byline.; Emmer Bart J author non-byline.; de Bruijn Sebastiaan F author non-byline.; van Dijk Lukas C author non-byline.; Van der worp H Bart author non-byline.; Lo Rob H author non-byline.; van Dijk Ewoud J author non-byline.; Boogaarts Hieronymus D author non-byline.; M de Kort Paul L author non-byline.; P Peluso Jo J author non-byline.; P van den berg Jan S author non-byline.; A M van Hasselt Boudewijn A author non-byline.; M Aerden Leo A author non-byline.; Dallinga René J author non-byline.; Uyttenboogaart Maarten author non-byline.; Eshghi Omid author non-byline.; C M L Schreuder Tobien H author non-byline.; J Heijboer Roel J author non-byline.; Keizer Koos author non-byline.; F Yo Lonneke S author non-byline.; Den Hertog Heleen M author non-byline.; C Sturm Emiel J author non-byline.; S Sprengers Marieke E author non-byline.; M Jenniskens Sjoerd F author non-byline.; den Berg René van author non-byline.; Yoo Albert J author non-byline.; M Beenen Ludo F author non-byline.; Roosendaal Stefan D author non-byline.; W van der Kallen Bas F author non-byline.; van den Wijngaard Ido R author non-byline.; Es Ad van author non-byline.; Emmer Bart author non-byline.; Vos Jan-Albert author non-byline.; Bot Joost author non-byline.; Doormaa Pieter-Jan van author non-byline.; Flach H Zwenneke author non-byline.; Lingsma Hester F author non-byline.; Ghannouti Naziha El author non-byline.; Sterrenberg Martin author non-byline.; Puppels Corina author non-byline.; Pellikaan Wilma author non-byline.; Sprengers Rita author non-byline.; Elfrink Marjan author non-byline.; Meris Joke de author non-byline.; Vermeulen Tamara author non-byline.; Geerlings Annet author non-byline.; Vemde Gina van author non-byline.; Simons Tiny author non-byline.; Rijswijk Cathelijn van author non-byline.; Messchendorp Gert author non-byline.; Bongenaar Hester author non-byline.; Bodde Karin author non-byline.; Kleijn Sandra author non-byline.; Lodico Jasmijn author non-byline.; Wollaert M author non-byline.; Jeurrissen D author non-byline.; Bos Erna author non-byline.; Drabbe Yvonne author non-byline.; Zweedijk Berber author non-byline.; Khalilzada Mostafa author non-byline.; Venema Esmee author non-byline.; Chalos Vicky author non-byline.; Compagne Kars J author non-byline.; Geuskens Ralph R author non-byline.; Straaten Tim Van author non-byline.; Ergezen Saliha author non-byline.; M Harmsma Roger R author non-byline.; Muijres Daan author non-byline.; Jong Anouk De author non-byline.; Hinseveld Wouter author non-byline.; Berkhemer Olvert A author non-byline.; M Boers Anna M author non-byline.; Huguet J author non-byline.; C Groot P F author non-byline.; Mens Marieke A author non-byline.; van kranendonk Katinka R author non-byline.; Treurniet Kilian M author non-byline.; Kappelhof Manon author non-byline.; Tolhuijsen Manon L author non-byline.; Alves Heitor author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 11:Number 9(2019)
• Page Start: 866
• Page End: 873
• Publication Date: 2019-02-18
• Subjects: stroke -- intervention -- ct angiography; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2018-014619
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Collateral status modified the effect of endovascular treatment (EVT) for stroke in several randomized trials. We assessed the association between collaterals and functional outcome in EVT treated patients and investigated if this association is time dependent. Methods: We included consecutive patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry (March 2014–June 2016) with an anterior circulation large vessel occlusion undergoing EVT. Functional outcome was measured on the modified Rankin Scale (mRS) at 90 days. We investigated the association between collaterals and mRS in the MR CLEAN Registry with ordinal logistic regression and if this association was time dependent with an interaction term. Additionally, we determined modification of EVT effect by collaterals compared with MR CLEAN controls, and also investigated if this was time dependent with multiplicative interaction terms. Results: 1412 patients were analyzed. Functional independence (mRS score of 0–2) was achieved in 13% of patients with grade 0 collaterals, in 27% with grade 1, in 46% with grade 2, and in 53% with grade 3. Collaterals were significantly associated with mRS (adjusted common OR 1.5 (95% CI 1.4 to 1.7)) and significantly modified EVT benefit (P=0.04). None of the effects were time dependent. Better collaterals corresponded to lower mortality (P<0.001), but not to lower rates of symptomatic intracranial hemorrhage (P=0.14). Conclusion: In routine clinical practice, better collateral status is associated with better functional outcome and greater treatment benefit in EVT treated acute ischemic stroke patients, independent of time to treatment. Within the 6 hour time window, a substantial proportion of patients with absent and poor collaterals can still achieve functional independence.